Delayed cord clamping (DCC) is a widely accepted practice endorsed by leading global health bodies, including the World Health Organization and the American College of Obstetricians and Gynecologists (ACOG). This procedure has become a standard component of childbirth care due to its established benefits for the newborn. A common question arises, however, regarding a potential side effect: whether this delay increases the risk of neonatal jaundice. Understanding the physiological relationship between DCC and the temporary yellowing of a newborn’s skin is necessary to assess the overall safety of the practice.
Understanding Delayed Cord Clamping
Delayed cord clamping is defined as postponing the clamping and cutting of the umbilical cord for a specific period after birth. For full-term, vigorous infants, ACOG recommends a delay of at least 30 to 60 seconds. Other organizations advocate for a minimum delay of one to three minutes, or until the umbilical cord stops pulsating.
The purpose of this delay is to allow a significant amount of placental blood to flow back to the infant, a process known as placental transfusion. This transfer can increase the newborn’s total blood volume by up to one-third. The majority of this beneficial blood transfer occurs within the first 60 seconds of life.
The Physiological Connection to Jaundice
The mechanism linking delayed cord clamping to jaundice begins with the increased blood volume the infant receives. This extra blood means the newborn has a higher concentration of red blood cells (RBCs) circulating in their system. RBCs have a limited lifespan and naturally break down through a process called hemolysis, which produces the yellow waste product called bilirubin.
Before birth, the mother’s placenta handles the removal of bilirubin from the fetal circulation. After birth, the newborn’s liver must take over this task, processing the bilirubin so it can be excreted. However, a newborn’s liver is often still maturing and takes time to work efficiently.
With the extra load of RBCs from the placental transfusion, the liver may be temporarily unable to process the resulting excess bilirubin quickly enough. This temporary buildup of bilirubin in the bloodstream causes the yellow discoloration of the skin and eyes, known as physiological jaundice.
Quantifying the Jaundice Risk
Delayed cord clamping is associated with an increased incidence of mild, physiological jaundice, detectable by higher transcutaneous bilirubin levels. However, this increase rarely translates into a higher incidence of severe hyperbilirubinemia requiring intensive intervention. Many studies have found no significant difference in the need for phototherapy between babies who received delayed versus immediate clamping.
A small number of studies have noted a marginal increase in the need for phototherapy in the delayed clamping group, but this remains a manageable condition. Phototherapy is the standard treatment, using special lights to convert bilirubin into a form the baby can easily excrete. Clinicians are aware of this slight risk and have monitoring protocols in place to manage any rapidly rising bilirubin levels.
Essential Benefits of Delayed Clamping
Despite the minor, manageable increase in the risk of jaundice, delayed cord clamping is the preferred standard of care because its benefits are substantial and long-lasting. The additional blood volume transferred provides the newborn with a significant boost of iron-rich blood. This extra iron is stored and helps prevent iron deficiency anemia later in infancy, particularly around four to six months of age.
Improved iron status is a significant outcome, as iron deficiency in early childhood can negatively affect neurological development. The placental transfusion also promotes better circulatory stabilization as the infant transitions to breathing air. The procedure has also been associated with improved hemoglobin levels in the first days of life.